提昇非小細胞肺癌病人手術後接受輔助性治療率之專案

The Project of Elevating The Rate of Receiving Adjuvant Chemotherapy in Patients with Non-Small Cell Lung Cancer

10.3966/102673012016032701005

邱惠英(Hui-Ying Chiu)；王儷螢(Li-Ying Wang)；鍾瑞齡(Jui-Ling Chung)；施麗雪(Li-Hsueh Shih)；王金洲(Chin-Chou Wang)；林孟志(Meng-Chih Lin)

非小細胞肺癌 ； 輔助性治療 ； 多專科團隊 ； non-small cell lung cancer ； adjuvant chemotherapy ； multidisciplinary team

長庚護理

27卷1期（2016 / 03 / 01）

47 - 57

繁體中文

早期非小細胞肺癌手術後，執行輔助性治療可提高存活率，而本院2012年非小細胞肺癌第I~IIIA期行手術治療有50人，接受術後輔助性治療僅20人(40%)，經現況分析發現主要原因為：肺癌術後輔助性治療指引欠缺完整、缺乏肺癌術後輔助性治療之討論機制、病人未接受肺癌術後輔助性治療護理指導及欠缺單張。本專案目的藉由修訂術後標準輔助性治療指引及訂定照護流程：包括多專科團隊提案討論與發揮個案管理師的角色功能、執行肺癌術後輔助治療之護理指導。2013年1月至8月經專案改善實施後，統計本院非小細胞肺癌病人接受手術治療有23人，術後輔助性治療達17人，術後輔助性治療率由原40%提昇為74%，顯示本專案的施行，確實能提昇非小細胞肺癌病人手術後輔助性治療之執行率，藉以提高照護品質及病人之存活率。

Adjuvant chemotherapy has been proven to improve the survival rate in patients with early stage non-small cell lung cancer. We reviewed the patients with stage I-IIIA non-small cell lung cancer in 2012. There were a total of 50 patients with stage I-IIIA patients who had received the operation. Among them, only 20 (40%) had received adjuvant chemotherapy. The major reasons for patients not receiving adjuvant chemotherapy were: unclear guidelines regarding adjuvant chemotherapy, poor communications among physicians, lack of an education program regarding adjuvant chemotherapy for patients, lack of educational sheets regarding adjuvant chemotherapy for patients. To improve patients with early (I-IIIA) stage non-small cell lung cancer receiving adjuvant chemotherapy, we amended the guidance of the adjuvant therapy after operation, established the caring protocols, such as proposal conferences by cancer collaboration teams, elaborated the roles and functions of care-managers, and provided nursing care for adjuvant therapy post-operation. After these interventions, 17 of 23 (74%) patients with early (I-IIIA) stage patients who received operation between January 2013 and August 2013 received adjuvant chemotherapy. The cooperation among professional team members provides patients with best treatment modalities that could improve overall survival rate.

1. 陳錫杰、蘇慧芳、賴美淑、謝碧晴(2010)。醫師的遵循行為可促進病患的存活嗎？以台灣非小細胞肺癌病患為例。台灣公共衛生雜誌，29(2)，118-130。
   連結：
2. National Comprehensive Cancer Networks (NCCN) (2013). NCCN clinical practice guidelines in oncology: Lung cancer. Retrieved from http://www. nccn.org/professionals/physician_ gls/f_guidelines.asp
3. Suehisa, H.,Toyooka, S.(2009).Adjuvant chemotherapy for completely resected monsmall-cell lung cancer.Acta Med.,63(5),223-230.
4. Vaismoradi, M.,Salsali, M.,Marc, P.(2011).Patient safety: Nursing students perspectives and the role of nursing education to provide safe care.International Nursing Review,58(4),434-442.
5. Williamson, K.(2008).An individualized telephone educational intervention for patients following coronary artery bypass graft surgery during the first three weeks after discharge.Self-care, Dependent-Care & Nursing,16(1),54-55.
6. Yun, Y. H.,Park, S. M.,Noh, D. Y.,Nam, S. J.,Ahn, S. H.,Park, B. W.,Lee, E. S.(2007).Trend in breast cancer treatment in Korea and impact of compliance with consensus recommendations on survival.Breast Cancer Res Treat,106(2),245-253.
7. 中央健康保險署（2014，4月）．全民健康保險藥物給付項目及支付標準． 取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=660&WD_ID=660&webdata_id=4295[Department of statistics, Ministry of Health and Welfare (2013). The National Health Insurance Pharmaceutical Benefits and Reimbursement Schedule. (2014, April). From http://www.nhi.gov.tw/webdata/webdata.aspx?menu=21&menu_id=713&WD_ID=849&webdata_id=2919]
8. 王照元(2008)。大腸直腸癌的輔助性化學治療。中華癌醫會誌，24(3)，180-184。
9. 白玉珠(2010)。應用個案管理照護模式於化學治療肺癌病人之成效。長庚護理，21(3)，277-286。
10. 阮瓊慧(2010)。高雄=Kaohsiung City, Taiwan, ROC，高雄醫學大學護理學研究所=Graduate Institute of Nursing, Kaohsiung Medical University。
11. 林麗英、黎國洪(2013)。建構腫瘤個案管理照護模式實務介紹。腫瘤護理雜誌，30(1)，53-58。
12. 邱燕甘、許玲女、郭美玲(2002)。化學治療病患接受護理指導之改善方案。長庚護理，13(4)，359-368。
13. 施穎銘、陳育民(2009)。非小細胞肺癌手術後輔助性化學治療。長庚護理，20(6)，490-496。
14. 張黎露(2010)。腫瘤個管師之發展與未來展望。腫瘤護理雜誌，10，1-9。
15. 陳偉武、洪敏瑛、陳幼貴(2010)。肺癌治療回顧及發展。腫瘤護理雜誌，10(2)，39-54。
16. 黃惠美、施智源、劉伯瑜(2012)。運用醫療團隊資源管理於感管政策的落實。感染控制雜誌，22，170-173。
17. 劉會平(2004)。肺癌的診斷與治療。腫瘤護理雜誌，4(2)，25-34。
18. 衛生福利部(2014，7月)．2011 年核心測量指標．取自https://pfp.hpa.gov.tw/Security/Login.aspx?target=/[Department of Health. Executive Yuan. R.O.C (Taiwan) (2014). 2011 Core measure, measure Retrieved July 11, 2014, from https://pfp.hpa.gov.tw/Security/Login.aspx?target=/]
19. 衛生福利部（2013，7月）．100年度死因統計．取自http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=12743&class_no=440&level_no=4電子書[Department of Health. Executive Yuan. R.O.C (Taiwan) (2013). 2011 Statistics of Causes of Death, (2013, July). Retrieved, from http://www.mohw.gov.tw/cht/DOS/Statistic_P.aspx?f_list_no=312&fod_list_no=2685&doc_no=13661]
20. 鄭惠鑫、陳雅惠、王琦、廖梅珍(2008)。婦癌病患於化學治療期間症狀困擾及護理指導需求之探討。腫瘤護理雜誌，8(2)，45-47。
21. 謝沛珊、李雅惠、曾麗華、連靖婷、朱以岑、邱秀渝(2011)。頭頸癌病人安全吞嚥照護流程之建立。榮總護理，28(4)，372-376。